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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Culprit lesion morphology in young patients with ST-segment elevated myocardial infarction: A clinical, angiographic
Chao Fang1, Jiannan Dai1, Shaotao Zhang1
1Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
Insights
Young adults experiencing ST-segment elevated myocardial infarction (STEMI) show distinct culprit lesion characteristics, with more plaque erosion and less vulnerable plaque features compared to older patients.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- ST-segment elevated myocardial infarction (STEMI) affects young adults, comprising about 20% of cases.
- The in vivo morphological characteristics of culprit lesions in young STEMI patients remain under-investigated.
Purpose of the Study:
- To investigate and compare the morphological characteristics of culprit lesions in young (≤50 years) versus older (>50 years) STEMI patients.
- Utilize optical coherence tomography (OCT) for detailed in vivo analysis of lesion morphology.
Main Methods:
- Included 1442 STEMI patients who underwent OCT examination of the culprit lesion.
- Divided patients into a young group (n=400, age ≤50 years) and an older group (n=1042, age >50 years).
- Compared clinical characteristics, angiography, and OCT findings between the two groups.
Main Results:
- Younger STEMI patients exhibited more plaque erosion (32.0% vs. 21.1%) and larger minimal lumen area (2.3±1.7 mm² vs. 1.9±1.1 mm²).
- Less frequent occurrences of lipid-rich plaque, thin-cap fibroatheroma (TCFA), calcification, spotty calcification, and cholesterol crystals were observed in young patients.
- Age ≤50 years was independently associated with less plaque rupture, TCFA, spotty calcification, cholesterol crystals, and smaller lumen area stenosis.
Conclusions:
- Morphological characteristics of culprit lesions in young STEMI patients differ significantly from those in older patients.
- Younger patients (≤50 years) present with a higher prevalence of plaque erosion and fewer vulnerable plaque features.
Background And Aims:
About 20% of patients with ST-segment elevated myocardial infarction (STEMI) are young adults. Morphological characteristics of culprit lesion in young STEMI patients have not been systematically evaluated in vivo. The present study aimed to investigate culprit lesion characteristics in young patients versus older patients using optical coherence tomography (OCT).
Methods:
1442 STEMI patients who underwent OCT examination of culprit lesion were included and divided into young group (age ≤50 years, n = 400) and older group (age >50 years, n = 1042). Clinical characteristics, angiography and OCT findings were compared between the two groups.
Results:
Culprit lesions in STEMI patients aged ≤50 years had more plaque erosion (32.0% vs. 21.1%, p < 0.001) and larger minimal lumen area (2.3 ± 1.7 mm2vs. 1.9 ± 1.1 mm2, p < 0.001) than in those aged >50 years. As compared with older patients, lipid rich plaque (80.5% vs. 87.2%, p = 0.001), thin cap fibroatheroma (TCFA, 59.5% vs. 69.5%, p < 0.001), calcification (31.3% vs. 48.7%, p < 0.001), spotty calcification (25.3% vs. 36.1%, p < 0.001) and cholesterol crystals (26.3% vs. 38.4%, p < 0.001) were less frequently observed in young patients. A gradient increase in typical plaque vulnerability was observed from age ≤50 years to 50-70 years to >70 years. In multivariate regression analysis, age ≤50 years was independently associated with less frequency of plaque rupture, TCFA, spotty calcification, cholesterol crystals and smaller lumen area stenosis.
Conclusions:
Morphological characteristics of culprit lesion in young STEMI patients were different from those in older patients. Patients aged ≤50 years had more plaque erosion and less vulnerable plaque features.
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